Respiratory disease

Question 1

Asthma’s effect on pregnancy

Pregnancies effect on asthma

Answer 1

Controlled asthma has no risk on pregnancy
Tx is lifestyle or SMART therapy or old management: SABA, inhaled steroids, LABA, leukotriene receptor antagonist, oral steroids

Asthma may improve or deteriorate or remain unchanged during pregnancy.
More severe more likely to deteriorate.
Postnatal deterioration can occur
Almost no attacks in labour

Question 2

Safety of drugs resp addition

Answer 2

Inhaled drugs are safe
Oral steroids: GDM, infection, ?cleft palate, ?PTB, unlikely in the doses needed for neurodevelopment of baby

Doxy abx shouldn’t be used after 20/40 due to discolouration of teeth

Question 3

Life threatening asthma

Answer 3

IV b2 agonist
IV mg sulphate
IV aminophylline

Question 4

Pneumonia in pregnancy

Answer 4

Reduction in cell mediated immunity renders pregnant women more susceptible to viral pneumonia, varicella zoster (chickenpox) pneumonia

Question 5

Varicella pneumonia

Answer 5

Incubation period 14-21 days.
Pregnant women susceptible.
Live vaccine should be given pre-pregnancy.
Give VZIG within 72hours and aciclovir
The fetus is at risk the first 12-16 weeks.
Detailed USS 5 weeks after (skin scarring, eye defects, limb hypoplasia, neurological abnormalities)
Neonatal varicella occurs if chickenpox happens within 10 days of delivery (30% mortality, give infant VZIG)

Question 6

TB
Sarcoidosis

Answer 6

TB: consider in pregnancy, safe to treat, neonates at risk,
Diagnosis must be confirmed bacteriologically eg bronchoscopy or biopsy, give BCG to neonate and isoniazide.

Sarcoidosis: multisystem disorder, can be noted on CXR, erythema nodosum may occur in normal pregnancies, the course of sarcoidosis is unaltered in pregnancy.
Avoid vitamin D which can precipitate hypercalciaemia.

Question 7

Cystic fibrosis

Answer 7

CF males usually sterile, female fertility only impaired by malnourishment and tenacious cervical mucus. Maternal mortality with CF is significantly increased but no different from others with CF. Survival positively correlated with pre-pregnancy predicted FEV1.
CF complications: Poor maternal weight gain, deterioration in lung function, pulmonary infective exacerbations, congestive cardiac failure.
Pregnancy complications: PTL, FGR.
Considerations: dietitian, lung function - physio, GS, GDM control (20% have diabetes and 15% have IGT), shortened second stage to avoid pneumothoraces, avoid GA.

Question 8

Severe restrictive lung disease

Answer 8

Eg kyphoscolosis, scleroderma, ILD
Mostly tolerated well exceptive <1L or <50% predicted FVC (loose guideline)
Women with kyphoscolosis often need CS delivery.